Rural Background rural interest rural practice
A collection of items from AAMC site search
Medical Students Venture Into Utah’s Rural and Frontier Areas to recruit their own
http://www.aamc.org/newsroom/reporter/oct02/cfc.htm
Med Schools Prepare Students to Practice in Rural Areas - not sure this is as encouraging to students and others about situations in rural practice http://www.aamc.org/newsroom/reporter/oct2000/rural.htm
Policy and Reimbursement including rural items http://www.aamc.org/advocacy/library/washhigh/2001/01mar23/_6.htm
Branch campuses on the increase - not sure this is true but good case for need to meet underserved needs and also be efficient with costs
http://www.aamc.org/newsroom/reporter/oct02/regional.htm
Community service, rpap and other med ed programs noted
http://www.aamc.org/data/aib/cime/vol3no1.pdf
Affirmative action - has some bearing on rural selections, still think it would be better to pick on service-orientation, maturation, coming from a poorer family - these do not have racial or rural vs urban overtones or other "discrimination" items
http://www.aamc.org/affirmativeaction
http://www.aamc.org/diversity/amicusbrieftext.pdf
MCAT data, by state, location, gender
http://www.aamc.org/students/mcat/examineedata/char99.pdf
BBRA
http://www.aamc.org/advocacy/library/teachhosp/hosp0047.htm
Med ed thru comm serve WWAMI
http://www.aamc.org/data/aib/camcam/vol4_no2.htm
Let me conclude with a few remarks about the geographic maldistribution of physicians in this country. This persistent problem must be solved. The solution, as our consensus statement indicates, will require programs specifically targeted to the root causes of the problem. Simply continuing to flood country with excess physicians, the vast majority of whom wind up in suburbia, will not do. It's like trying to fill a salt shaker with a snow shovel--you get a lot of salt on the table before you accomplish the goal of filling the shaker. And let me shatter a common myth. Graduates of foreign medical schools are not more likely than graduates of U.S. schools to settle in underserved rural areas. Many have and my hat's off to them. But the fact is that a higher proportion of U.S. graduates than foreign graduates end up in permanent practice in rural America. In any event, given the projected large surplus of physicians, it makes no sense from a public policy point of view for this country to try to rely on another country's graduates to do this job. We must, and we can, find ways to solve the problem of medically underserved Americans with our own graduates. http://www.aamc.org/meded/edres/workforc/aamc.htm
Basco, W.T., Jr., Gilbert, G.E., & Blue, A.V.(2002). Determining the Consequences for Rural Applicants When Additional Consideration is Discontinued in a Medical School Admission Process. Academic Medicine, 77, S20-S22.
http://www.aamc.org/students/mcat/research/bibliography/basco002.htm
RESULTS: There were 2,033 in-state applicants with complete data (not missing MCAT scores) in the four cohorts. Rural applicants comprised between 8.5% and 9.7% of applicants, depending on the year. MCAT science scores for rural applicants were significantly lower in three of the four, but Verbal Reasoning scores were not significantly different between rural and non-rural applicants. Mean GPAs were not significantly different either. In three of the four years, rural applicants were half as likely to have attended undergraduate schools in the more competitive Barron's categories, but these differences reached statistical significance in only one year-1998. Without the adjustment for rural applicant status, the median ranks of rural applicants were lower than those for non-rural applicants in all four years. Across all four years the adjustment for being a rural applicant had a marked positive effect for rural applicants while having minimal effects on non-rural applicants. The adjustment for rural status did not ensure an admission interview for every rural applicant, but it did mean that a large majority of the rural applicants received admission interviews in all four years. Without the adjustment, fewer than half of the rural applicants would have received admission interviews in two of the years evaluated-1997 and 1999.
Volume 10, Number 6 March 2001
I have used these pages frequently to exhort the academic medicine community to recognize — and address — one or another of its many public obligations. Today I want, instead, to exhort our public policy-makers to recognize an obligation that we in academic medicine have long been prepared to address but in which we have been stymied by a lack of the governmental cooperation needed to succeed. The obligation in question is rectifying the serious and persistent geographic maldistribution of physicians.
Of all the barriers preventing access to health care services, geographic inaccessibility is arguably of longest standing. With the demise of Norman Rockwell’s iconic, horse-and-buggy family doc, and with the centralization of essential medical technologies, physicians have tended more and more to congregate around large cities.
The reasons that physicians have shunned rural locations (and many inner-city locations, as well) are multiple and understandable; they include concern about isolation from colleagues, lack of employment opportunities for their spouses, limited educational options for their children, realistic assessment of the economic viability of their practices, and an unwillingness to forgo the cultural and social amenities of urban America.
The consequence of physicians’ preferences for city life, however, is that far too many Americans are unable to obtain adequate health care solely because of where they live. Some 47 million of our countrymen now reside in locations designated by the federal government as health professional shortage areas (HPSAs), and most of these are in rural America.
Of all the efforts, both private and public, to redress the geographic maldistribution of health care professionals, none has been more successful than the National Health Service Corps (NHSC). Indeed, the NHSC is virtually the only bright spot in what is an increasingly dim outlook for our rural-bound citizens. In its nearly 30 years of existence, the NHSC has placed tens of thousands of health care professionals in underserved and medically vulnerable areas, where more than half of them continue to provide care long after their NHSC commitment is over. And, of course, while they are serving in the Corps, they are fully committed to this task, often as the sole provider for the communities to which they are assigned.
Why then, given this success, are so many rural and inner-city areas still plagued by a severe shortage of clinicians? The answer, in no small part, can be traced to the paucity of funding made available to NHSC over the years. Congressional appropriations for the Corps have never been commensurate either with the magnitude of the maldistribution problem or with the large number of students prepared to serve in the Corps.
Current funding levels are sufficient to provide only 12 percent of the clinicians needed by underserved communities. What’s more, inadequate funding forces the NHSC to turn away more than a thousand health care professionals every year who are prepared to meet these needs. Last year, for example, 3,000 clinicians, including more than 700 allopathic physicians, applied for NHSC scholarships and loan repayment programs. Funds were available, however, to award only about 18 percent of scholarship applications and 40 percent of loan repayment applications.
Adding irony to the public health dilemma posed by the geographic maldistribution of health care providers is the urgent need to relieve the mounting debt burden of medical school graduates. The educational debt accumulated by medical students has more than doubled since 1990. The latest figures indicate that over 80 percent of medical school graduates have unpaid loans, which, on average, exceed $90,000. Can anyone doubt that such a huge financial burden discourages many dedicated young physicians from practicing in rural and inner-city communities?
So, there you have it. Huge numbers of people without access to health care because of where they live; a federal program designed specifically to fix the problem; hundreds, perhaps thousands, of medical students prepared to join the program; and countless more lost to the cause altogether because crushing debt squelches any desire they might have to care for our nation’s poor and underserved.
Here is a rare opportunity for public policy to address two major problems with a single stroke — a veritable 2-fer. By a relatively modest (by federal standards) increase in funding for the NHSC, we get immediate help in closing the geographic gap in access to health care and some relief from the unconscionable indebtedness now afflicting our students. Not a bad deal.
I hope you’ll join me in pressing this case before Congress as it prepares to reauthorize the NHSC this year.
Jordan J. Cohen, M.D. AAMC President
Jordan J. Cohen, M.D.
AAMC President
Volume 9, Number 13 Oct 2000
Physicians are in increasingly short supply in rural communities nationwide. A staggering 20 million Americans in rural communities have inadequate access to health care services, according to Health Resources and Services Administration estimates.
Not only are salaries lower in rural communities but a host of potential drawbacks - including poor employment opportunities for partners and spouses, quality of education concerns for children, and lack of a supportive physician community - cause doctors to shy away from bucolic practice.
Concerned that rural areas are dangerously underserved, medical schools are striving to provide students with both the requisite experience and funding for rural practice. Here's what three schools, all of which are the only medical school in an underserved state, are doing to prepare future physicians to care for their states' rural residents.
The University of Vermont College of Medicine
"The economic realities of Vermont create a cycle that discourages graduates from practicing here," says Mildred Reardon, M.D., University of Vermont's associate dean for Primary Care.
Eight of Vermont's 14 counties fall below federal standards for the ratio of primary care physicians to area residents. Below average salaries in those counties haven't helped matters, particularly given the fact that Vermont medical students graduate with loan debt higher than the national average.
With an $8 million gift from the Stowe, Vt.-based Freeman Foundation, the University of Vermont College of Medicine has established a scholarship program that will help make practicing medicine in the state fiscally viable. The gift will provide $1.6 million in scholarships annually for the next four years to in-state students and a select group of out-of-staters who demonstrate a willingness to commit to practicing medicine in Vermont. Dr. Reardon adds that the College of Medicine will try to actively place these students in communities that have medical needs that match their specialization.
The remaining funds, $400,000 per year, will support programs aimed at educating students about rural health care - an area in which Dr. Reardon says the school is already well-versed. The school's existing rural health promotion strategies include a mentoring program in which first- and second-year students are paired with a community physician and numerous clerkship rotations in rural communities across the state.
The University of Mississippi School of Medicine.
In Mississippi, almost every area is rural and underserved. The University of Mississippi School of Medicine's efforts to promote rural medicine got a large boost last January when Mississippi Gov. Ronnie Musgrove signed into law House Bill 729. The legislation provides annually 20 $20,000 scholarships to medical school students who pledge to serve 10 years in an underserved area of the state.
"Students will graduate with no or minimal debt, making them feel more liberated to practice in an underserved community that might not be able to offer a competitive salary," says Melessa Phillips, M.D., chair of Family Medicine at the University of Mississippi School of Medicine.
Because of the state's rural health care needs, the school has been working for more than 20 years to incorporate aspects of rural medicine into its curriculum, Dr. Phillips says. For example, third-year medical students can work in a rural practice, oftentimes living with a community physician, to experience the day-to-day life of a Mississippi doctor.
The University of North Dakota School of Medicine
Money isn't everything, as North Dakota has learned. Despite higher than average physician salaries and several state loan repayment programs, North Dakota has trouble attracting physicians to rural practice. As a state-owned and supported school, the University of North Dakota aims to help, says Mary Amundson, director of the Office of Primary Care at the university's School of Medicine.
The school has incorporated rural medicine into its curriculum and developed in-depth rural medicine experiences, including an eight-month, self-directed learning experience for third-year students. Amundson says this community-based learning approach has been successful in acclimating students to rural environments.
The University of North Dakota's Center for Rural Health also works to improve access to primary care for underserved and vulnerable populations by, among others, developing a primary care access plan for all of North Dakota's counties, organizing a statewide recruitment fair for health care professionals, and coordinating the state's loan repayment program for physicians and nurses.
But given the fact that more than 7 percent of rural Americans don't have sufficient access to health care services, medical schools still have a long road ahead of them when it comes to remedying the dearth of physicians in underserved areas. "We're a very rural state, and we continue to have a shortage of doctors," Mississippi's Dr. Phillips says. "Everything helps, and sometimes we just get lucky."
Accreditation and Demands of Rural Practice